Intestinal intussusception related to colonic pedunculated lipoma: A case report and review of the literature

Abstract

Introduction: Intestinal intussusception is a relatively common cause of bowel obstruction in children, however, it is a rare clinical entity in adults. When seen in adults, it is often caused by some underlying condition, usually of malignant origin. We present a case of intestinal intussusception caused by a benign and rare condition in the gastrointestinal tract.

Case presentation: A 69-year-old male patient presented with diffuse abdominal pain for 2 months, which intensified in the last two days, associated with diarrhea, vomiting and weight loss, in addition to sporadic episodes of hematochezia. Colonoscopy revealed a vegetative-infiltrative lesion, occupying about 75% of the lumen of the colon, located in the hepatic angle, presumably neoplastic. A biopsy was performed, which revealed mild nonspecific chronic inflammation in activity, in fragments of colonic mucosa. CT scan demonstrated colo-colonic intussusception, associated to an oval formation presenting fat density, suggesting lipoma. The patient underwent laparotomy with intussusception reduction and right partial colectomy. The inspection of the specimen showed a yellowish, pedunculated lesion. Histopathology confirmed a 5.0 cm submucosal lipoma.

Discussion: Intestinal intussusception is relatively frequent in children and is a rare clinical condition in adults at a ratio of 20:1.4. Sixty to sixty-five percent of the cases of intussusception in the large intestine have malignant etiology. Thus, lipoma as the main cause of colo-colonic intussusception in adults is an uncommon cause.

Conclusion: Although rare, colonic lipoma should be considered as a differential diagnosis among the causes of large intestinal intussusception in adults.

Keywords: Abdominal pain; Case report; Colon; Intussusception; Lipoma; Multidetector computed tomography.

Fig. 1

Vegetative-infiltrative neoplasic lesion with irregular contours, occupying about 75% of the lumen of the colon, located in hepatic angle.

Fig. 2

A – CT scan, coronal section in portal phase: Intestinal invagination extending longitudinally by 20.7 cm. The segments involved present normal parietal enhancement by the iodinated contrast media. B – CT scan, sagittal section in portal venous phase: Head of the intussusceptum related to the fat densit, round formation, measuring 7.3 × 3.8 × 4.1 cm. C – CT scan, axial section in portal venous phase: Head of the intussusceptum related to the fat densit, round formation, measuring 7.3 × 3.8 × 4.1 cm.

Fig. 3

Surgical specimen demonstrating a resected segment of the colon and pedunculated lipoma.